Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness that primarily affects infants and young children. It is caused by several different types of enteroviruses, most commonly, Enterovirus 71 (EV71) and Coxsackievirus A16 (CA16). This condition is characterized by fever, sore throat, and blister-like lesions on the hands, feet, and mouth.
HFMD was first recognized in New Zealand in 1957. However, it likely existed prior to that but was not formally identified. Initially, it was believed to be solely caused by Coxsackievirus A16. However, with the development of advanced laboratory techniques and improved diagnostic methods, other enteroviruses like EV71 were also identified as causative agents of HFMD.
HFMD is prevalent globally and is endemic in many parts of the world. However, it is more commonly reported in the Asia-Pacific region, including countries such as China, Japan, Singapore, Malaysia, and Taiwan. Outbreaks are more prevalent during the warmer months and tend to occur in cyclical patterns every few years. While the disease is also found in other regions, such as Europe, North America, and Africa, its incidence is lower.
Transmission of HFMD usually occurs through direct contact with nose and throat discharges, saliva, fluid from blisters, and feces of infected individuals. The virus can also spread through respiratory droplets, such as through coughing or sneezing. It can survive on surfaces outside the body for several hours, increasing the risk of transmission via contaminated objects or surfaces.
Although HFMD affects people of all ages, children under the age of five are most susceptible due to their developing immune systems and lack of previous exposure. In densely populated areas such as daycares, schools, and boarding facilities, there is an increased risk of transmission. Additionally, the virus can be transmitted from mother to baby during childbirth.
The major risk factors associated with HFMD transmission include poor personal hygiene practices, close contact with infected individuals, and crowded living conditions. Lack of proper handwashing, sharing of contaminated objects, and failure to cover the mouth and nose when coughing or sneezing contribute to the spread of the virus.
The impact of HFMD varies across different regions and populations. In the Asia-Pacific region, particularly in countries like China and Taiwan, large-scale outbreaks occur periodically, affecting thousands of children. The disease can lead to severe complications in some cases, including viral meningitis, encephalitis, myocarditis, and acute flaccid paralysis.
Prevalence rates and affected demographics can differ within regions and even within countries. For example, in China, HFMD cases are more prevalent in rural areas compared to urban regions. This disparity may be due to differences in healthcare access, sanitation, and population density. Certain demographics, such as young children in crowded environments, are at a higher risk of infection and severe complications.
In conclusion, HFMD is a globally prevalent viral illness primarily affecting children. The disease is transmitted through direct contact with infected fluids and feces, as well as respiratory droplets. Risk factors include poor personal hygiene, crowded living conditions, and close contact with infected individuals. HFMD has a significant impact on different regions and populations, with variations in prevalence rates and affected demographics. Efforts to prevent and control the disease focus on maintaining good hygiene practices, early detection, and appropriate medical care.

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Seasonal Patterns: The data reveals clear seasonal patterns for cases of Hand, Foot, and Mouth Disease (HFMD) in mainland China. The number of cases consistently rises in the spring and summer months (March to July) and declines in the fall and winter months (August to February). This pattern indicates a peak in HFMD transmission during the warmer months.
Peak and Trough Periods: The peak period for HFMD cases in mainland China is observed in June and July, with the highest number of reported cases during these months. The trough period, with the lowest number of cases, occurs in January and February. This pattern indicates a peak in the summer and a trough in the winter.
Overall Trends: When considering the overall trend of HFMD cases in mainland China, there has been a gradual increase in cases from 2010 to 2011, reaching a peak in 2014. After 2014, the number of cases showed a decreasing trend until it reached its lowest point in 2020. However, since 2020, there has been an upward trend in the number of reported cases, with a substantial increase in July 2023.
Discussion: The seasonal pattern of HFMD cases in mainland China aligns with the known transmission dynamics of the disease, as the enterovirus causing HFMD thrives in warm and humid conditions. The peak period in the summer months likely corresponds to increased outdoor activities and close contact among individuals, facilitating the transmission of the virus. The decrease in cases during the winter months can be attributed to lower temperatures and reduced opportunities for transmission.
The overall trend suggests that there have been fluctuations in the incidence of HFMD in mainland China over the years. The peak in 2014 may be attributed to various factors, such as changes in population susceptibility, variation in viral strains, or changes in reporting practices. The subsequent decline in cases until 2020 could possibly be attributed to increased awareness and implementation of preventive measures. However, the recent upward trend in cases since 2020, particularly in July 2023, requires further investigation to understand the factors driving this increase.
Continued monitoring of HFMD cases in mainland China is crucial, as well as further investigation into the factors influencing the observed patterns and trends. This information can be valuable in developing effective strategies for the prevention and control of HFMD in the future.